Trauma-related failure of a continuous-flow left ventricular assist device (LVAD) has not previously been reported. We present 4 cases in which LVAD complications were likely caused by external trauma and led to failure of a HeartMate II device. In 1 case, the onset of symptoms was delayed and the patient did not seek medical attention until months after the traumatic event. All 4 patients required surgical intervention, and 1 patient died of respiratory complications several months postoperatively. In conclusion, a history of external trauma should be considered as a possible etiologic factor when LVAD-supported patients in previously stable condition present with device malfunction.
The development of small, durable, continuous-flow left ventricular assist devices (LVADs) has improved the outcomes and quality of life of patients with end-stage heart disease. The most widely used LVAD is the HeartMate II (HMII; Thoratec Corporation, Pleasanton, California), which was recently approved by the United States Food and Drug Administration for both bridge to heart transplantation and destination therapy. Patients with this device are able to leave the hospital and resume a normal lifestyle. Therefore, they are at risk for the types of injuries and accidents encountered in everyday life. The published works contain no previous reports of external trauma resulting in LVAD malfunction. We describe 4 cases of significant HMII malfunction encountered in patients who had a history of external trauma.
Case Series
Four male patients (age range, 15 to 78 years) received HMII LVADs at our institution and were later readmitted with complications related to device malfunction. All 4 patients had a history of external trauma before readmission. The report of their cases was approved by our Institutional Review Board.
Table 1 lists the 4 cases, each of which involved a different type of LVAD malfunction and set of symptoms. Patients 3 and 4 did not seek medical attention immediately after the traumatic event, so a direct causal link is difficult to prove. Although patient 3 waited 3 weeks before presenting to the clinic, the patient reported experiencing a “full sensation” around the pump at the time of the accident, suggesting that the damage occurred at that time. In case 4, the trauma occurred 14 months before the patient presented with hemolysis, but we speculate that the anteroposterior displacement of the pump from its original position may have resulted from the accident. Three of the patients recovered uneventfully after treatment, but patient 2 developed complications, including infection and intracranial hemorrhage, and died of respiratory complications several months later.
| Patient No. | Age (Yrs) | Type of Trauma | Hospital Presentation | Symptoms | Operative Findings | Treatment |
|---|---|---|---|---|---|---|
| 1 | 15 | Fall | Immediate | LVAD low-flow alarm | Driveline fracture ( Figure 1 ) | LVAD exchange |
| 2 | 42 | Blow to chest | 48 h | Pain | Hematoma, pseudoaneurysm; sewing ring separation ( Figures 2 and 3 ) | Sewing ring repair ∗ |
| 3 | 58 | Fall | 3 weeks | “Fullness,” pain | Bleeding from torn LVAD outflow graft | LVAD exchange |
| 4 | 78 | Fall | 14 mo | Bloody urine | Pump displacement ( Figures 4 and 5 ); kinked inlet cannula ( Figures 6 and 7 ) | LVAD exchange |
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